Disparities/Minority Health

Among various racial/ethnic groups, Native Americans have the highest rate of smokeless tobacco (ST) use. Chewing tobacco can lead to a host of health conditions, including oral cancers and gum disease. A recent study of two Native American tribes found an increased use of ST in Native Americans with post-traumatic stress disorder (PTSD) from the Northern Plains tribe. However, it found no significant association between ST use and PTSD among those from the Southwest tribe.

The researchers investigated the link between the use of ST and the presence of three mental health disorders (PTSD, panic disorder, and major depression) in two tribes. The study included 1,506 members of a Northern Plains tribe and 1,268 members of a tribe located in the Southwest. Structured interviews were conducted by other trained tribal members to obtain information on ST and cigarette smoking history, alcohol use, and demographics. Each participant was also evaluated for the presence of PTSD, panic disorder, and major depression.

Both tribes had similar rates of ST use: 31 percent for the Northern Plains tribe and 30 percent for the Southwest tribe. Users in the Northern Plains were younger than non-users, while Southwest users were older. Alcohol use disorder was more prevalent among lifetime ST users from both tribes. No association was found between lifetime ST use and the presence of either panic disorder or major depression. However, those with PTSD in the Northern Plains tribe had a 1.6 times higher odds of ST use. This association was not found in the Southwest tribe.

For both tribes, the researchers discovered increased odds for ST use as the number of coexisting psychiatric diagnoses increased. They note that the association between ST use and psychiatric disorders is not as strong overall as it is for cigarette smoking. The study was supported in part by AHRQ (HS10854).

See "Smokeless tobacco use and its relation to panic disorder, major depression, and posttraumatic stress disorder in American Indians," by Craig N. Sawchuk, Ph.D., Peter Roy-Byrne, M.D., Carolyn Noonan, M.S., and others in the September 2012 Nicotine & Tobacco Research 14(9), pp. 1048-1056.